PCC Technical Framework Wikified

HIMSS and RSNA
Integrating the Healthcare Enterprise

IHE Patient Care Coordination

Technical Framework
Volumes I and II

Revision 2.0
2006-2007

Draft

Comments may be submitted to:

http://forums.rsna.org under the “IHE” forum
Select the appropriate sub-forum for the technical framework you are commenting upon.

Forward

Integrating the Healthcare Enterprise (IHE) is an initiative designed to stimulate the integration of the information systems that support modern healthcare institutions. Its fundamental objective is to ensure that in the care of patients all required information for medical decisions is both correct and available to healthcare professionals. The IHE initiative is both a process and a forum for encouraging integration efforts. It defines a technical framework for the implementation of established messaging standards to achieve specific clinical goals. It includes a rigorous testing process for the implementation of this framework. And it organizes educational sessions and exhibits at major meetings of medical professionals to demonstrate the benefits of this framework and encourage its adoption by industry and users.

The approach employed in the IHE initiative is not to define new integration standards, but rather to support the use of existing standards, HL7, DICOM, IETF, and others, as appropriate in their respective domains in an integrated manner, defining configuration choices when necessary. When clarifications or extensions to existing standards are necessary, IHE refers recommendations to the relevant standards bodies.

This initiative has numerous sponsors and supporting organizations in different medical specialty domains and geographical regions. In North America the primary sponsors are the American College of Cardiology (ACC), the Healthcare Information and Management Systems Society (HIMSS) and the Radiological Society of North America (RSNA). IHE Canada has also been formed. IHE Europe (IHE-EUR) is supported by a large coalition of organizations including the European Association of Radiology (EAR) and European Congress of Radiologists (ECR), the Coordination Committee of the Radiological and Electromedical Industries (COCIR), Deutsche Röntgengesellschaft (DRG), the EuroPACS Association, Groupement pour la Modernisation du Système d'Information Hospitalier (GMSIH), Société Francaise de Radiologie ([www.sfr-radiologie.asso.fr SFR]), and Società Italiana di Radiologia Medica (SIRM). In Japan IHE-J is sponsored by the Ministry of Economy, Trade, and Industry (METI); the Ministry of Health, Labor, and Welfare; and [www.medis.or.jp MEDIS-DC]; cooperating organizations include the Japan Industries Association of Radiological Systems (JIRA), the Japan Association of Healthcare Information Systems Industry (JAHIS), Japan Radiological Society (JRS), Japan Society of Radiological Technology (JSRT), and the Japan Association of Medical Informatics (JAMI). Other organizations representing healthcare professionals are actively involved and others are invited to join in the expansion of the IHE process across disciplinary and geographic boundaries.

The IHE Technical Frameworks for the various domains (Patient Care Coordination, IT Infrastructure, Cardiology, Laboratory, Radiology, etc.) define specific implementations of established standards to achieve integration goals that promote appropriate sharing of medical information to support optimal patient care. These are expanded annually, after a period of public review, and maintained regularly through the identification and correction of errata. The current version for these Technical Frameworks may be found at www.ihe.net.

The IHE Technical Framework identifies a subset of the functional components of the healthcare enterprise, called IHE Actors, and specifies their interactions in terms of a set of coordinated, standards-based transactions. It describes this body of transactions in progressively greater depth. Volume I provides a high-level view of IHE functionality, showing the transactions organized into functional units called Integration Profiles that highlight their capacity to address specific clinical needs. Subsequent volumes provide detailed technical descriptions of each IHE transaction.

Content of the Technical Framework

This technical framework defines relevant standards and constraints on those standards in order to implement a specific use cases for the transfer of information between systems. This document is organized into 2 volumes as follows:

Volume 1 – Overview

This volume is provided as a high level overview of the profiles including descriptions of the use case, the actors involved, the process flow, and dependencies on other standards and IHE profiles. It is of interest to care providers, vendors' management and technical architects and to all users of the profile

Volume 2 – Transactions and Content Profiles

This volume is intended as a technical reference for the implementation of specific transactions in the use case including references to the relevant standards, constraints, and interaction diagrams. It is intended for the technical implementers of the profile.

How to Contact Us

IHE Sponsors welcome comments on this document and the IHE initiative. They should be directed to the discussion server at http://forums.rsna.org or to:

Didi Davis
Director of Integrating the Healthcare Enterprise
230 East Ohio St., Suite 500
Chicago, IL 60611
Email: ihe@himss.org

Volume 1

Preface to Volume 1 of the PCC Technical Framework

Intended Audience

The intended audience of this document is:

• Healthcare professionals involved in informatics
• IT departments of healthcare institutions
• Technical staff of vendors participating in the IHE initiative
• Experts involved in standards development
• Those interested in integrating healthcare information systems and workflows

Related Information for the Reader

The reader of volume 1 should read or be familiar with the following documents:

• Volume 1 of the Cross-Enterprise Document Sharing (XDS) Integration Profile documented in the ITI Infrastructure Technical Framework

(See http://www.ihe.net/Technical_Framework/index.cfm ).

• Volume 1 of the Notification of Document Availability (NAV) Integration Profile documented in the ITI Infrastructure Technical Framework

(See http://www.ihe.net/Technical_Framework/index.cfm ).

• Volume 1 of the Audit Trail and Node Authentication (ATNA) Integration Profile documented in the ITI Infrastructure Technical Framework

(See http://www.ihe.net/Technical_Framework/index.cfm ).

• HL7 Clinical Document Architecture Release 2: Section 1, CDA Overview.
• Care Record Summary – Implementation Guide for CDA Release 2 (US Realm): Section 1
• Presentations from IHE Workshop: Effective Integration of the Enterprise and the Health System - June 28–29, 2005: http://www.ihe.net/Participation/workshop_2005.cfm, June 2005:
• Leveraging IHE to Build RHIO Interoperability
• Cross-Enterprise Document Sharing (XDS)
• Notification of Document Availability (NAV)
• Patient Care Coordination
• Use Cases for Medical Summaries
• Patient Care Coordination - Overview of Profiles

How this Volume is Organized

Section 2 describes the general nature, structure, purpose and function of the Technical Framework. Section 3 and the subsequent sections of this volume provide detailed documentation on each integration profile, including the Patient Care Coordination problem it is intended to address and the IHE actors and transactions it comprises.

The appendices following the main body of the document provide a summary list of the actors and transactions, detailed discussion of specific issues related to the integration profiles and a glossary of terms and acronyms used.

Conventions Used in this Document

This document has adopted the following conventions for representing the framework concepts and specifying how the standards upon which the IHE Technical Framework is based should be applied.

Technical Framework Cross-references

When references are made to another section within a Technical Framework volume, a section number is used by itself. When references are made to other volumes or to a Technical Framework in another domain, the following format is used:

<domain designator> TF-<volume number>: <section number>

where:

<domain designator>

is a short designator for the IHE domain (PCC= Patient Care Coordination, ITI = IT Infrastructure, RAD = Radiology)

<volume number>

is the applicable volume within the given Domain Technical Framework (e.g., 1, 2, 3), and

<section number>

is the applicable section number.

For example: PCC TF-1: 3.1 refers to Section 3.1 in volume 1 of the IHE Patient Care Coordination Technical Framework, ITI TF-2: 4.33 refers to Section 4.33 in volume 2 of the IHE IT Infrastructure Technical Framework.

IHE Actor and Transaction Diagrams and Tables

Each integration profile is a representation of a real-world capability that is supported by a set of actors that interact through transactions. Actors are information systems or components of information systems that produce, manage, or act on categories of information required by operational activities in the enterprise. Transactions are interactions between actors that communicate the required information through standards-based messages.

The diagrams and tables of actors and transactions in subsequent sections indicate which transactions each actor in a given profile must support.

The transactions shown on the diagrams are identified both by their name and the transaction number as defined in PCC TF-2 (Volume 2 of the PCC Technical framework). The transaction numbers are shown on the diagrams as bracketed numbers prefixed with the specific Technical Framework domain.

In some cases, a profile is dependent on a prerequisite profile in order to function properly and be useful. For example, Cross-Enterprise Sharing of Medical Summaries depends on Audit Trail and Node Authentication (ATNA). These dependencies can be found by locating the desired profile in the dependencies section of this document to determine which profile(s) are listed as prerequisites. An actor must implement all required transactions in the prerequisite profiles in addition to those in the desired profile.

Process Flow Diagrams

The descriptions of integration profiles that follow include process flow diagrams that illustrate how the profile functions as a sequence of transactions between relevant actors.

These diagrams are intended to provide an overview so the transactions can be seen in the context of an institution’s or cross-institutions’ workflow. Certain transactions and activities not defined in detail by IHE are shown in these diagrams in italics to provide additional context on where the relevant IHE transactions fit into the broader scheme of healthcare information systems. These diagrams are not intended to present the only possible scenario. Often other actor groupings are possible, and transactions from other profiles may be interspersed.

In some cases the sequence of transactions may be flexible. Where this is the case there will generally be a note pointing out the possibility of variations. Transactions are shown as arrows oriented according to the flow of the primary information handled by the transaction and not necessarily the initiator.

Copyright Permissions

Health Level Seven, Inc., has granted permission to the IHE to reproduce tables from the HL7 standard. The HL7 tables in this document are copyrighted by Health Level Seven, Inc. All rights reserved. Material drawn from these documents is credited where used.

IHE has been very fortunate in having the American College of Obstetricians and Gynecologists (ACOG) help us in the definition of the data found in the Antepartum Summary Profile (APS).

The Antepartum Summary Profile (APS) describes the content structures and specifications the American College of Obstetricians and Gynecologists (ACOG) views are necessary in an antepartum record. ACOG encourages the use of the content structures contained in the Antepartum Summary Profile of the Patient Care Coordination Technical Framework. ACOG does not endorse any EMR products. Companies or individuals that use these content structures in EMR product or service are prohibited from using ACOG's name and/or its logo on any promotional material, packaging, advertisement, website or in any other context related to the EMR product or service.

Braden Scale For Predicting Pressure Sore Risk, Copyright © Barbara Braden and Nancy Bergstrom, 1988. Reprinted with permission. Barabara Braden and Nancy Bergstrom have granted permission to use the Braden Scale in the IHE Functional Status Assessment Integration Profile to be provided to vendors for demonstration purposes only. Should a vendor chose to include the Braden Scale in their product, they must seek permission to do so from the copyright holders. More information is available from http://www.bradenscale.com/